Swallowing (cont.)

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What causes dysphagia?

As discussed previously, there are many causes of dysphagia. For convenience, causes of dysphagia can be classified into two groups;

oropharyngeal (meaning that the cause is a problem in the mouth or pharynx) and

esophageal.

Causes also can be classified differently into several groups.

Physical obstruction of the pharynx or esophagus

Benign and malignant tumors of the pharynx and esophagus. Most commonly these tumors are malignant.

Tumors of the tissues surrounding the pharynx and esophagus. These tumors can compress the pharynx and esophagus leading to obstruction. This is an unusual cause of dysphagia. An example would be thyroid cancer.

Narrowing (strictures) of the esophagus. The strictures usually are due to GERD and are located in the lower esophagus. These strictures are the result of ulcerations of the esophagus that heal, with scarring as a result. Less common causes of strictures include ingestion of acid or lye during attempts at suicide, some pill medications that may stick in the esophagus and cause ulceration and scarring, for example,potassium chloride ( K-Dur, K-Lor, K-Tab, Kaon CL, Klorvess, Slow-K, Ten-K, Klotrix, K-Lyte CL), doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others),quinidine (Quinidine Gluconate, Quinidine Sulfate), biphosphonates used for treatingosteoporosis), radiation therapy, and infections of the lower esophagus, particularly in people with AIDS.

Schatzki's rings. These rings are benign, very short narrowings (millimeters) at the lower end of the esophagus. The cause of Schatzki's rings is unknown though some physicians believe they are caused by GERD.

Infiltrating diseases of the esophagus. The most common infiltrative disease is a disease in which the wall of the esophagus fills with eosinophils, a type of white blood cell involved in inflammation. This disease is called eosinophilic esophagitis. The wall of the esophagus becomes stiff and cannot stretch as the bolus of food passes. As a result, the bolus sticks.

Diverticuli (outpouchings) of the pharynx or esophagus. The diverticuli can expand when it fills with swallowed food and can compress the pharynx or esophagus. The diverticuli can be at the upper end of the esophagus (Zenker's diverticulum) or, less commonly, at the middle or lower end of the esophagus.

Cricopharyngeal bars. These bars represent a part of the upper esophageal sphincter that has hypertrophied, that is, expanded. The bar does not stretch normally as the bolus passes. The cause of cricopharyngeal bars is unclear. Small bars that do not interfere with swallowing are quite common.

Cervical osteophytes. Rarely, arthritis of the neck results in an overgrowth of bone that extends anteriorly out from a vertebra (an osteophyte). Since the vertebrae of the neck lie immediately behind the lower pharynx and uppermost esophagus, the osteophyte may impinge on the pharynx and esophagus.

Congenital abnormalities of the esophagus. These abnormalities are present from birth and are almost always discovered in infants because of problems when oral feeding begins.